Predictive Impact of Prognostic Nutritional Index in Patients with Cancer Treated with Immune Checkpoint Inhibitors: A Systematic Review and Meta-Analysis

Abstract

A few previous studies have investigated the prognostic value of the prognostic nutritional index (PNI) in patients treated with immune checkpoint inhibitors (ICIs); however, the results are inconsistent. Therefore, this study aimed to clarify the prognostic significance of PNI. The PubMed, Embase, and Cochrane Library databases were searched. A meta-analysis of the impact of PNI on overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and rate of adverse events (AEs) in patients treated with ICIs was performed. Twenty-three studies involving 2,386 patients were included. Low PNI was associated with significantly poor OS (hazard ratio [HR] = 2.26, 95% confidence interval [CI]: 1.81–2.82, P < .001) and short PFS (HR = 1.75, 95% CI: 1.54–1.99, P < .001). Patients with low PNI tended to have a low ORR (odds ratio [OR] = 0.47, 95% CI: 0.34–0.65, P < .001) and DCR (OR = 0.43, 95% CI: 0.34–0.56, P < .001). However, the subgroup analysis demonstrated no significant association between PNI and survival time in patients receiving a programmed death ligand-1 inhibitor. PNI was significantly associated with survival time and treatment efficacy in patients treated with ICIs.

Acknowledgments

The authors would like to acknowledge the editorial support received from Yi Zhen and Chenjiang Ying.

Ethics approval and consent to participate

All analyses were based on previously published studies; thus, no ethical approval or patient consent was required.

Author contribution statement

Xin Jin: Conceptualization, Methodology, Formal Analysis, Writing - Review and Editing. Xin-tian Xu: Methodology, Formal Analysis, Writing - Review and Editing. Yu Qian: Methodology, Formal Analysis, Writing - Review and Editing. Meng-xing Tian: Methodology, Writing - Review and Editing. Chen-chen Ding: Formal Analysis. Huan Guo: Formal Analysis. Jing Tang: Writing - Review and Editing. Yuan Wu: Writing - Review and Editing. Guo-liang Pi: Resources. Zhu Dai: Resources. All authors have discussed, reviewed, and approved the final version of the manuscript.

Disclosure statement

The authors declare that they have no competing interests.

Availability of data and materials

The datasets in this study are available from the corresponding author on reasonable request.

Additional information

Funding

This work was supported by a grant from Health Commission of Hubei Province scientific research project (number: WJ2021M194) to Yu Qian, and China Primary Health Care Foundation (Clinical Nutrition Development Research Fund Project) to Guo-liang Pi.